The overall goal of this application is to develop and validate a novel ultrasound-based device for low-cost, unobtrusive, and noninvasive daily in-home arterial blood pressure (ABP) measurement that requires minimal user training and interaction. The proposed research seeks to significantly reduce the barrier for frequent patient-based ABP assessment, thereby helping to increase compliance with ABP-lowering protocols and reducing hypertension-related morbidity, mortality, and healthcare expenditure in the United States and low- income countries. In pursuit of this goal, we will leverage ultrasound-based approaches to tissue elastography and vascular imaging to determine absolute ABP (Specific Aim 1). In a system-integration step, we will leverage our strength in microelectronic system design to miniaturize the prototype to a form factor the size of a typical cell phone (Specific Aim 2). Additionally, we will develop and evaluate an intuitive workflow model that assumes minimal patient training and patient participation in the measurement step (Specific Aim 2). The hardware design and algorithm development will be aided by concurrent pre-clinical studies that provide important data and feedback to the study team for iterative algorithm, device, and workflow refinement (Specific Aim 3). Finally, the accuracy and precision of the developed integrated system will be evaluated in a prospective validation study in hypertensive patients recruited from a cardiology clinic (Specific Aim 3). The study team brings together deep expertise in clinical ultrasound technology (Drs. Brian Anthony and Kai Thomenius, MIT), microelectronic system design (Drs. Charles Sodini and Harry Lee, MIT), physiological modeling and signal processing (Dr. Thomas Heldt, MIT), and clinical medicine (Dr. Collin Stultz, MIT and Boston VA Medical Center), and leverages the combined resources of MIT's Institute for Medical Engineering and Science, Medical Electronic Device Realization Center, Microsystems Technology Laboratory, and Research Laboratory of Electronics to ensure optimal and synergistic support for this research project.